dic puerperral sepsis. puerperal sepsis bacterial infection of genital tract after delivery....
TRANSCRIPT
DICPUERPERRAL SEPSIS
Puerperal sepsis
• Bacterial infection of genital tract after delivery.
• Organism :polymicrobial
• Mode of infection:Exogenous: external sourcesEndogenous: organism already present in genital tract-anaerobic
streptococci.Autogenous: from septic focus in the patient
Puerperal sepsis
• Predisposing factorsGeneral causes: anaemia, diabetes
Local causes: ROM, laceration, retained placenta
• Site of infection:Primary: laceration, placental bed, retained tissueSecondary: tubes, ovaries, peritonium, parametrium, pelvic veins
pathology
• Localized= putrid endometritis= mild formInfection is limited to the superficial layer of endometrium
• Spreading=septic endometritis= severe form
The endometrium is the commonest site of puerperal sepsis
Clinical picture• Infected tears: local pain , mild fever, dysuria
• Endometritis: fever in the 3rd day, lower abdominal pain , tender uterus, offensive excessive lochia
• Septicaemia: 3rd or 4th day, high temp, pulse rapid, lochi is scanty and not offensive
• Salpingooophoritis:
• Parametritis: 2nd week
• Peritonitis
• Pelvic thrombophlebitis: 2nd week, mild fever,
Investigation
• CBC+ Diff WCC
• Blood culture
• MSU , culture sensitivity
• Cervicovaginal swab
• Ultrasound
• ? X ray chest, widal test, blood film for malaria
ttt
• Prophylactic:During pregnancy: ttt anaemia
During labour: aseptic condition, VE <, antibiotic if SROM > 18H, complete delivery of placenta,
Puerperium:avoid hospital acquired infection,
ttt
• General measures
• Antibiotic
• Drainage : fowler, semisitting,
• Heparin for pelvic vein thrombosis
DIC
• Normal fibrinogen 400-600mg%• Bleeding from DIC –fibrinogen <=100mg%
Causes of DIC
• Abruptio placenta 60-70%• Missed miscarriage• IUFD• Sepsis• AF embolism• Severe preeclampsia and eclampsia• Massive bleeding• Massive blood transfusion• Incompatable blood transfusion• Acute fatty liver of pregnancy
Diagnosis of DIC• Bleeding per nose , haematuria
• Bleeding from puncture sites
• PPH
• Clot observation test= Weiner test =bed sit test
Failure of any clots in 5ml tube blood within 10 minutes indicate fibrinogen ?100mg%
If a clot forms the tube incubated at 37c . If clot dissolves after 30 minutes it means excessive fibrinolytic activity
Diagnosis of DIC• Low fibrinogen
• FDP > 40 micrograms/ml
• Platelet < 100,000/cumm
• Prothrombin time is increased ( N 10-15 second)
• Thrombin time is increased ( N 25-35 second)
• PTT is increased ( N 25-35 Second)
• Antithrombin 111 deficiency
• D-Dimers is increased > 0-5 microgram/ml is abnormal
Treatment of DIC• Treat the cause: infection-antibiotic
• Fresh blood
• Fresh FP
• Cryoprecipitate
• Give platelet if Platelets <50,000
• Antithrombin 111 adminstration
• Heparin to increase fibrinogen
Treatment of DIC
Remember• Dextran more than one liter may cause DIC
• Dextran interferes with cross matching
• One unit platelets raises the platelet count by 10,000/mm3
• Each unit cryoprecipitate raise the fibrinogen level by 10mg/dl
• One liter of FFP Supplies 3 gm fibrinogen and all clotting factors